Trends and patterns of smoking in the South African adult population: 1995-1998

Masters Research: Faculty of Health SciencesBackground Smoking is undoubtedly a major risk factor for morbidity, disability and premature death. Its use results in grave health and economic losses not only to the individual but also to the population and the world at large. Many surveys have been done in South Africa to estimate the prevalence of smoking. It is therefore imperative and expedient to have an overall impression of the prevalence rates over time. And also it is important to assess how subgroups affect the prevalence and trends in the national population. This will be of help in determining which subgroups have achieved reduction in smoking prevalence and which have not; evaluating the tobacco control policies in the country; and in designing specific interventions. This research was undertaken to determine the trends and patterns of smoking in the South African adult population Objectives The objectives for this study were: Regarding the South African adult population during 1995 – 1998, to: 1. Compute the prevalence of smoking and assess the trends of smoking prevalence. 2. Assess the patterns and trends of smoking prevalence in subgroups by sex, age, marital status, race, locality (urban or rural), education and province. 3. Identify factors in the population that may account for patterns and trends in smoking prevalence over time 4. Make recommendations regarding the public health implications of the findings 5 Methods This was an analytical study involving secondary analysis of existing datasets from four South African representative national surveys. From 11 surveys, which measured smoking in the South African population, four surveys were selected using some inclusion and exclusion criteria. The population of interest was the South Africa adult population (18 – 49), so variables of interest (outcome variable was current smokers) for this group were extracted. Prevalence (frequency) rates estimation of smoking in the national population and in subgroups were then estimated. Unadjusted odds ratios and adjusted odds ratios were computed by bi-variate cross tabulation and multivariate logistic regression respectively. Time-trend analyses (Maentel Haenszel chi-squared test) were computed by logistic regression for trend in proportions Results From 1995 to 1997 about 1/3 of the adult South African population were smokers, but that dropped significantly to about ¼ in 1998. For the period however, there was no significant trend. The prevalence of smoking varied with, and was largely depended on population subgroup; while it was as high as 63.9% among Coloured males, 62.3% among Coloured females, 53.7 % among all males, 52.7% among rural males, it was as low as 11.4% among all females, 6.8% among rural females, 10.83% among Indian females and 5.06% among Black females. The only significant trends was an increasing smoking prevalence among Blacks, Coloured men, people with tertiary education, Free State and Gauteng provinces, age group 35 – 44; urban men and a decreasing smoking prevalence in all women, urban women and black women, age group 18 – 24 and the Eastern Cape, Kwazulu-Natal, Northen Cape and Mpumalanga provinces. Sex, race, age, and education were the major risk factors for smoking in th

Trends and patterns of smoking in the South African adult population: 1995-1998

ABSTRACT Background Smoking is undoubtedly a major risk factor for morbidity, disability and premature death. Its use results in grave health and economic losses not only to the individual but also to the population and the world at large. Many surveys have been done in South Africa to estimate the prevalence of smoking. It is therefore imperative and expedient to have an overall impression of the prevalence rates over time. And also it is important to assess how subgroups affect the prevalence and trends in the national population. This will be of help in determining which subgroups have achieved reduction in smoking prevalence and which have not; evaluating the tobacco control policies in the country; and in designing specific interventions. This research was undertaken to determine the trends and patterns of smoking in the South African adult population Objectives The objectives for this study were: Regarding the South African adult population during 1995 – 1998, to: 1. Compute the prevalence of smoking and assess the trends of smoking prevalence. 2. Assess the patterns and trends of smoking prevalence in subgroups by sex, age, marital status, race, locality (urban or rural), education and province. 3. Identify factors in the population that may account for patterns and trends in smoking prevalence over time 4. Make recommendations regarding the public health implications of the findingsMethods This was an analytical study involving secondary analysis of existing datasets from four South African representative national surveys. From 11 surveys, which measured smoking in the South African population, four surveys were selected using some inclusion and exclusion criteria. The population of interest was the South Africa adult population (18 – 49), so variables of interest (outcome variable was current smokers) for this group were extracted. Prevalence (frequency) rates estimation of smoking in the national population and in subgroups were then estimated. Unadjusted odds ratios and adjusted odds ratios were computed by bi-variate cross tabulation and multivariate logistic regression respectively. Time-trend analyses (Maentel Haenszel chi-squared test) were computed by logistic regression for trend in proportions Results From 1995 to 1997 about 1/3 of the adult South African population were smokers, but that dropped significantly to about ¼ in 1998. For the period however, there was no significant trend. The prevalence of smoking varied with, and was largely depended on population subgroup; while it was as high as 63.9% among Coloured males, 62.3% among Coloured females, 53.7 % among all males, 52.7% among rural males, it was as low as 11.4% among all females, 6.8% among rural females, 10.83% among Indian females and 5.06% among Black females. The only significant trends was an increasing smoking prevalence among Blacks, Coloured men, people with tertiary education, Free State and Gauteng provinces, age group 35 – 44; urban men and a decreasing smoking prevalence in all women, urban women and black women, age group 18 – 24 and the Eastern Cape, Kwazulu-Natal, Northen Cape and Mpumalanga provinces. Sex, race, age, and education were the major risk factors for smoking in the South African adult population. Locality (rural/urban) though had different smoking rate was not a risk factor for smoking. Marital status was neither a determinant nor risk factor for smoking. Discussion and Conclusion The prevalence of smoking in the South African adult population is very high and did not achieve any significant trend between 1995 and 1998. However the significant drop from 1997 to 1998 probably means that smoking prevalence in the national population may have started declining; therefore, more monitoring is needed to ascertain this. This high prevalence of smoking in the South African population, which may have been for years, may predict a high burden of chronic smoking-related diseases in the near future. The patterns of smoking analyses reveal that smoking in the South African adult population is determined by a complex interplay of different factors

Alcohol use and sexual risk behaviour among men and women in inner-city Johannesburg, South Africa.

BACKGROUND: Alcohol misuse is a key factor underlying the remarkable vulnerability to HIV infection among men and women in sub-Saharan Africa, especially within urban settings. Its effects, however, vary by type of drinking, population group and are modified by socio-cultural co-factors. METHODS: We interviewed a random sample of 1465 men living in single-sex hostels and 1008 women in adjacent informal settlements in inner-city, Johannesburg, South Africa. Being drunk in the past week was used as an indicator of heavy episodic drinking, and frequency of drinking and number of alcohol units/week used as measures of volume. Associations between dimensions of alcohol use (current drinking, volume of alcohol consumed and heavy episodic drinking patterns) and sexual behaviours were assessed using multivariate logistic regression. RESULTS: Most participants were internal migrants from KwaZulu Natal province. About half of men were current drinkers, as were 13% of women. Of current male drinkers, 18% drank daily and 23% were drunk in the past week (women: 14% and 29% respectively). Among men, associations between heavy episodic drinking and sexual behaviour were especially pronounced. Compared with non-drinkers, episodic ones were 2.6 fold more likely to have transactional sex (95%CI = 1.7-4.1) and 2.2 fold more likely to have a concurrent partner (95%CI = 1.5-3.2). Alcohol use in men, regardless of measure, was strongly associated with having used physical force to have sex. Overall effects of alcohol on sexual behaviour were larger in women than men, and associations were detected between all alcohol measures in women, and concurrency, transactional sex and having been forced to have sex. CONCLUSIONS: Alcohol use and sexual behaviours are strongly linked among male and female migrant populations in inner-city Johannesburg. More rigorous interventions at both local and macro level are needed to alleviate alcohol harms and mitigate the alcohol-HIV nexus, especially among already vulnerable groups. These should target the specific dimensions of alcohol use that are harmful, assist women who drink to do so more safely and address the linkages between alcohol and sexual violence

Iron indices in adults with sickle cell nephropathy in Lagos, Nigeria

Introduction: Although several studies have explored iron indices in patients with sickle cell anaemia (SCA), there is a paucity of evidence regarding the iron status of patients with sickle cell nephropathy (SCN). This study evaluated the range of iron status of adult SCA patients with or without nephropathy in Lagos, Nigeria.Methods: This was a cross-sectional study performed at the Sickle Cell Clinic of the Lagos University TeachingHospital (LUTH). Patients who were aged 18–65 years were assessed for SCN by determining the albumin-to creatinine ratio (UACR) on a spot urine sample, and determining the estimated glomerular filtration rate, using the CKD–EPI formula, on a steady-state serum creatinine concentration. Iron indices including serum ferritin, serum iron and total iron-binding capacity (TIBC) were measured, and percentage transferrin saturation (TSAT) was calculated. Data were analysed with the Statistical Package for the Social Sciences (SPSS) version 23. Results: A total of 200 patients were included, of whom 119 had SCN. There were no statistically significantdifferences in iron indices in participants with or without SCN. The median serum ferritin and TSAT of patients with SCN were 265 ng/mL and 31.8%, respectively, while the values were 255 ng/mL and 33.5% in those without SCN, respectively. Few participants were noted to have iron overload based on ferritin and TSAT values, regardless of SCN diagnosis. Although not statistically significant, females tended to have higher ferritin and serum iron values compared to males, irrespective of the presence or absence of SCN; whereas females without SCN had statistically significant higher TSAT values compared to males without SCN (36.2 ± 15.0% and 28.8 ± 11.5%, P = 0.03).Conclusion: Although iron overload is common in patients with SCA, our findings indicate that patients with SCNmay require routine evaluation of iron indices because few were iron overloaded. For this reason, the evaluation of iron indices in patients with SCN should be individualised to guide the direction of care and improve clinicaloutcomes. &nbsp

Allergenicity of latex rubber products used in South African dental schools

Background: Allergens from latex products in healthcare settings have been known to trigger latex induced allergic reactions in healthcare workers (HCWs). There is a need to quantify individual latex allergens in products in order to assess the allergenicity of latex products used in health care settings, so as to minimize the risk of sensitisation to these proteins. Methods: Fourteen latex examination gloves representing six brands (powdered and non-powdered) and five dental rubber dams from five dental academic institutions were analysed for latex allergens and total protein. Total protein content was determined using the BIORAD DC protein assay kit and natural rubber allergen levels using a capture ELISA assay specific for hev b 1, hev b 3, hev b 5 and hev b 6.02. Results: Hev b 6.02 was found in higher concentrations than other NRL allergens in the products analysed. Hev b 5 content ranged from 0 to 9.2µg/g and hev b 6.02 from 0.09 to 61.5µg/g of sample. Hev b 1 levels were below the detection limit (DL) for 79% of the samples (15/19). Dental dams showed higher allergen levels (median: 80.91µg/g) in comparison to latex gloves (median: 11.34µg/g). Powdered rubber samples also showed higher allergen levels (median: 40.54µg/g) compared to non-powdered samples (median: 5.31µg/g). A statistically significant correlation was observed between total protein and total allergen (r=0.74, p<0.001) concentrations. Conclusion Natural rubber latex (NRL) allergen concentrations differ significantly by product and brand. This study has demonstrated that NRL allergens in latex containing products used in South African dental institutions are present at sufficiently high levels to pose an allergic health risk

Time-to-pregnancy and pregnancy outcomes in a South African population

<p>Abstract</p> <p>Background</p> <p>Time-to-pregnancy (TTP) has never been studied in an African setting and there are no data on the rates of adverse pregnancy outcomes in South Africa. The study objectives were to measure TTP and the rates of adverse pregnancy outcomes in South Africa, and to determine the reliability of the questionnaire tool.</p> <p>Methods</p> <p>The study was cross-sectional and applied systematic stratified sampling to obtain a representative sample of reproductive age women for a South African population. Data on socio-demographic, work, health and reproductive variables were collected on 1121 women using a standardized questionnaire. A small number (n = 73) of randomly selected questionnaires was repeated to determine reliability of the questionnaire. Data was described using simple summary statistics while Kappa and intra-class correlation statistics were calculated for reliability.</p> <p>Results</p> <p>Of the 1121 women, 47 (4.2%) had never been pregnant. Mean gravidity was 2.3 while mean parity was 2.0 There were a total of 2467 pregnancies; most (87%) resulted in live births, 9.5% in spontaneous abortion and 2.2% in still births. The proportion of planned pregnancies was 39% and the median TTP was 6 months. The reliability of the questionnaire for TTP data was good; 63% for all participants and 97% when censored at 14 months. Overall reliability of reporting adverse pregnancy outcomes was very high, ranging from 90 - 98% for most outcomes.</p> <p>Conclusion</p> <p>This is the first comprehensive population-based reproductive health study in South Africa, to describe the biologic fertility of the population, and provides rates for planned pregnancies and adverse pregnancy outcomes. The reliability of the study questionnaire was substantial, with most outcomes within 70 - 100% reliability index. The study provides important public information for health practitioners and researchers in reproductive health. It also highlights the need for public health intervention programmes and epidemiological research on biologic fertility and adverse pregnancy outcomes in the population.</p

Risk Factors of In-Hospital Mortality in Patients Treated for Pneumonia at a Tertiary Care Centre in Switzerland

Background: Little is known about risk factors upon hospital admission that are associated with in-hospital death of patients hospitalized for bacterial pneumonia. Identifying such factors may help to optimize the treatment and lower the mortality of these patients. Objectives: The aim of the study was to characterize baseline characteristics of patients hospitalized for bacterial pneumonia in Switzerland and to identify risk factors associated with all-cause in-hospital mortality. Methods: Routinely collected electronic health record data of patients discharged from a large Swiss tertiary care hospital between August 2009 and 2017 were analysed. Potential risk factors such as patient demographics, physical examination findings, vital signs, laboratory results, and comorbidities were considered within ±24 h of admission. Univariable and multivariable logistic regression models identified risk factors for in-hospital death. The area under the receiver operating characteristic (ROC) curve was used to compare the identified factors to existing pneumonia scoring systems. Results: Out of 1,781 hospital stays with initial and main diagnosis of bacterial pneumonia, 85 patients (4.85%) died (33.9% female, median age 62.3 years [interquartile range, 52–75]). Age, low systolic blood pressure, underweight, a missing value for body mass index, decreased haemoglobin level, raised C-reactive protein, high urea, high lactate dehydrogenase, concomitant pleural effusion, and cancer were independently associated with in-hospital death. The area under the ROC curve was 0.89 for the multivariable model containing the identified predictors. Conclusions: Our data are consistent with previous trials characterizing patients hospitalized for pneumonia. Additionally, we identified new and independent risk factors associated with in-hospital death among patients treated for bacterial pneumonia. Findings need to be further validated in larger multicentre cohorts

Trends in lung cancer mortality in South Africa: 1995-2006

Abstract Background Cancer remains a major cause of morbidity and mortality worldwide. In developing countries, data on lung cancer mortality are scarce. Methods Using South Africa's annual mortality and population estimates data, we calculated lung cancer age-standardised mortality rates for the period 1995 to 2006. The WHO world standard population was used as the reference population. Scatter plots and regression models were used to assess linear trends in mortality rates. To better characterise emerging trends, regression models were also partitioned for defined periods. Results Lung cancer caused 52,217 deaths during the study period. There were 4,525 deaths for the most recent year (2006), with men accounting for 67% of deaths. For the entire South African population, the age-standardised mortality rate of 24.3 per 100,000 persons in 1995 was similar to the rate of 23.8 per 100,000 persons in 2006. Overall, there was no significant decline in lung cancer mortality in South Africa from 1995 to 2006 (slope = -0.15, p = 0.923). In men, there was a statistically non-significant annual decline of 0.21 deaths per 100,000 persons (p = 0.433) for the study period. However, from 2001 to 2006, the annual decline of 1.29 deaths per 100,000 persons was statistically significant (p = 0.009). In women, the mortality rate increased significantly at an annual rate of 0.19 per 100,000 persons (p = 0.043) for the study period, and at a higher rate of 0.34 per 100,000 persons (p = 0.007) from 1999 to 2006. Conclusion The more recent declining lung cancer mortality rate in men is welcome but the increasing rate in women is a public health concern that warrants intervention. Smoking intervention policies and programmes need to be strengthened to further reduce lung cancer mortality in men and to address the increasing rates in women.</p